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Optimal Oral and Dental Routine

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Tools

Toothbrush

Electric vs. Manual

Both electric and manual toothbrushes are effective at cleaning your teeth as long as you use them properly. However, some people may prefer electric toothbrushes for various reasons, such as:

  • They have limited manual dexterity or mobility issues, making it challenging to brush by hand.
  • They tend to brush too hard or fast and damage their gums or enamel since certain electric toothbrushes can indicate when too much pressure is applied.
  • They need help to brush for the right amount of time and reach all areas of their mouth.

If you decide to use an electric toothbrush, opt for one from a reputable manufacturer, such as Sonicare or Oral-B.

Size and Shape of Toothbrush Head

The size and shape of the toothbrush head should match the size and shape of your mouth. A toothbrush head that is too large may not be able to reach all the surfaces of your teeth. Using a small toothbrush head may take longer to clean your teeth, although they are generally preferable since they are more precise and are better at reaching all surfaces of your teeth. You may also want to look for a toothbrush head with a curved shape that follows the contours of your teeth and gums.

Bristle Texture

There are three types of bristle textures: soft, medium, and hard.

Use a soft-bristled toothbrush, as they are the least prone to damaging your gums and enamel and can effectively clean plaque and debris from your teeth.1

Medium-bristled toothbrushes may be, and hard-bristled toothbrushes are, almost certainly, too abrasive and may cause gum recession, enamel erosion, or tooth sensitivity. Unless specifically recommended otherwise by your dentist, use a soft-bristled toothbrush, avoiding brushing with excessive pressure or duration.

Product Recommendations

Replace the toothbrush head every three months or once the bristles start fraying.

Toothpaste

Fluoride

Look for toothpaste with a high fluoride concentration of around 1500 parts per million (or 500 ppm for children). If cavities/caries are and continue to be an issue, consider a prescription toothpaste with even higher concentrations of fluoride (e.g., PreviDent or CariFree PRO Gel 5000).2 While fluoride is widely endorsed by dental and medical associations for its role in preventing cavities, some individuals prefer to avoid it, particularly for young children, due to concerns about overexposure or ingestion. For those who choose to avoid fluoride, nano-hydroxyapatite (n-HA) is a scientifically supported alternative that may aid in tooth remineralization.3

Other Ingredients

In addition to fluoride, also consider finding a toothpaste that has:

  • Xylitol—xylitol interferes with the growth of bacteria that can cause cavities and increases salivation, which raises the pH of the mouth and, thereby, aids in the prevention of dental caries. Xylitol also stimulates saliva flow, which helps neutralize acids and remineralize enamel.
  • Nano-hydroxyapatite (n-HA)—enamel is primarily comprised of hydroxyapatite, and n-HA may aid in the remineralization of your enamel.

Relative Dentin Abrasion (RDA)

Generally, look for toothpaste with a lower RDA to avoid damaging your enamel.4 “Sensitive”, “strengthening”, and “remineralizing” kinds of toothpaste tend to have a lower RDA. “Whitening” and “tarter control” kinds of toothpaste tend to have a higher RDA and should generally be avoided. The exception is if your teeth accumulate some staining, such as from drinking coffee and tea, in which case you may want to use a whitening toothpaste periodically (e.g., once a week).

Product Recommendations

Floss

Floss is one of the primary tools for preventing and treating periodontal (gum) disease. Flossing cleans tooth surfaces that a toothbrush cannot reach, particularly between teeth and under the gumline where plaque accumulates and may cause gum disease and cavities. String floss is the best since it provides the greatest ability for manual manipulation; although floss picks can be more convenient, they are not as good. Use a floss threader if you have braces, permanent retainers, or a bridge.

Product Recommendations

Water Flosser

Water flossers help remove food that standard floss and a toothbrush may be unable to dislodge. However, because water flossers do not effectively remove biofilm, they should not be used in place of regular flossing and should only be used to supplement regular flossing.

Product Recommendations

Interdental Brush

Interdental brushes can be particularly helpful for dealing with periodontal (gum) disease. Be careful to get the right size(s). If they are too large, using them can irritate your gums.

Product Recommendations

Mouthwash

Look for a mouthwash that contains fluoride and, optionally, xylitol.5 Avoid mouthwash that has alcohol because alcohol can dry out your mouth, and any intense flavors since they may cause you to salivate and dilute the fluoride from the mouthwash. Alcohol and flavoring can also be irritating to your mouth and gums. If gingivitis or periodontal disease is an issue, consider using mouthwash with cetylpyridinium chloride (CPC) or tea tree oil. Be sure not to swallow any mouthwash or tea tree oil.

Product Recommendations

Tongue Scraper

Halitosis (bad breath) is predominantly caused by bacteria on your tongue, so regular tongue cleaning with a tongue scraper can significantly aid in the reduction of halitosis by reducing overall bacterial load.6

Product Recommendations

Mints and Chewing Gum

The right kinds of mints and chewing gum can be helpful when access to traditional tools is less accessible, such as when you are traveling or otherwise on the go. Look for mints or chewing gum that contain xylitol.

Product Recommendations

Techniques

Brushing

General Technique

  • For the outside and inside surfaces of your teeth, use the Modified Bass Technique:
    • Target 1-2 teeth at a time.
    • Angle the toothbrush ~45 degrees from the surface of your teeth toward your gums.
    • Make small circular strokes (or if using an electric toothbrush, hold it in place with minimal stroking as the oscillation or vibration of the toothbrush does the work), then sweep the toothbrush in the direction away from the gums.
  • For the biting surfaces of your teeth, scrub with a back-and-forth motion.

Considerations

  • Brush gently, which should be sufficient to remove plaque. Applying too much pressure while brushing may lead to gum damage or recession.
  • Wait at least 30 minutes after eating any acidic foods before brushing since brushing before then can damage the enamel of your teeth.7
  • Use a mirror while brushing to ensure proper technique.
  • It’s generally recommended to brush for at least two minutes since that’s typically how long it takes to brush all surfaces of your teeth properly.
  • Replace the toothbrush or toothbrush head every three months (or sooner if the bristles are fraying). If the bristles are fraying before three months of use, you’re likely applying too much pressure when brushing.
  • Don’t rinse or consume any food or liquid for 30 minutes after brushing since that would wash away the fluoride. Don’t even rinse with mouthwash since mouthwashes typically have lower fluoride concentrations than toothpaste and will dilute the fluoride concentration in your mouth.

Flossing

For each tooth, use a clean segment of floss. Press the floss against each side of the tooth, hugging the tooth (making a “V” shape), and move the floss up and down, not side to side, a few times. The floss should go slightly below the gumline while flossing. Consider adding toothpaste in between your teeth prior to flossing (aka toothpaste flossing).

Mouthwash

The purpose of using mouthwash is to complement otherwise good dental hygiene by coating your teeth with fluoride throughout the day and/or killing the bacteria in your mouth, depending on the type of mouthwash you use, when you are not brushing your teeth with toothpaste (e.g., after lunch or dinner or a snack in the middle of the day).

Don’t rinse or consume any food or liquid for 30 minutes after using mouthwash since that would wash away the fluoride.

Since a good toothpaste will have higher concentrations of fluoride than mouthwash, mouthwash should not be used alongside toothbrushing on the same occasion (i.e., you should not brush your teeth and then rinse with mouthwash immediately afterward) since that would dilute the concentration of fluoride in your mouth.

Routine

General Sequence of Cleaning

  • Floss—to remove food particles and biofilm from the sides of your teeth so that fluoride from the toothpaste can access those areas when brushing your teeth.8
  • Clean your tongue with a tongue scraper and/or a toothbrush—to remove biofilm and bacteria from your tongue.
  • Use a water floss or rinse—to flush everything away.
  • Brush your teeth—brush last so that the fluoride from the toothpaste can achieve maximum contact with your teeth (since you’ve already flossed and water flossed to remove food particles and biofilm) and so that the fluoride from the toothpaste remains in your mouth (which wouldn’t be the case if you were to water floss or rinse afterward).

Morning

Your morning oral and dental routine should be performed ideally at least 30 minutes after breakfast or upon waking if you don’t eat breakfast; if you can’t wait that long after breakfast, before breakfast is acceptable.

  • Floss if any food from breakfast is stuck in between your teeth.
  • Clean your tongue with a tongue scraper and/or a toothbrush.
  • Brush your teeth—brushing after breakfast removes food in the mouth from breakfast and allows the fluoride from the toothpaste to remain in your mouth for an extended period of time before the next time you consume any food or liquid, which will wash away the fluoride.
  • Don’t rinse or consume any food or liquid for 30 minutes after brushing.

After Lunch or Snacking

  • Floss if any food is stuck in between your teeth.
  • Rinse with mouthwash. Consider applying a small amount of toothpaste onto your teeth instead if that is all that is available.
  • Don’t rinse with water or consume food or liquid for 30 minutes after rinsing with mouthwash.

After Dinner

  • Floss if any food from dinner is stuck in between your teeth.
  • Rinse with mouthwash. Consider applying a small amount of toothpaste onto your teeth instead if that is all that is available.
  • Don’t rinse with water or consume any food or liquid for 30 minutes after rinsing your mouth with mouthwash.

Before Bed

  • Floss your teeth.
  • Clean your tongue with a tongue scraper and/or a toothbrush.
  • Use a water floss.
  • Brush your teeth.
  • Do not consume any food or liquid (other than water) until the next day; don’t rinse or drink water for 30 minutes after brushing.

Other Considerations

  • Regular dental check-ups and professional cleanings—every 6 months for most—are recommended for general maintenance and early detection of issues, as well as removal of calculus (hardened plaque) that can’t be removed by brushing and flossing alone.
  • If your teeth accumulate staining, such as from drinking coffee or tea, use a whitening toothpaste once a week. If the staining isn’t coming off from brushing with a soft-bristled toothbrush, consider polishing your teeth using a cloth or tissue and the whitening toothpaste, applying only very gentle pressure. However, this may best be left for visits to the dentist to avoid damage to your enamel.
  • Minimize the frequency of food and drink consumption (i.e., the number of times you consume any food and liquid (other than water)) throughout each day, so avoid snacking as much as possible.9
  • Minimize the intake of sugar or any refined carbohydrates.
  • Drink water regularly throughout the day, particularly with and after consuming any food or liquid, to wash away any residual food, acids, and sugars in your mouth.
  • Avoid smoking, which can lead to problems including bad breath, tooth discoloration, inflammation, and other issues.10
  1. https://pubmed.ncbi.nlm.nih.gov/21842020/ ↩︎
  2. https://pmc.ncbi.nlm.nih.gov/articles/PMC6398117/; https://adavb.org/publicassets/17588702-96b6-ea11-a2b8-b0d6fd09413e/ADA-Fluoride-Guidelines-Resource-2020.pdf ↩︎
  3. https://pmc.ncbi.nlm.nih.gov/articles/PMC4252862/ ↩︎
  4. https://pubmed.ncbi.nlm.nih.gov/26349126/ ↩︎
  5. https://www.ada.org/resources/ada-library/oral-health-topics/mouthrinse-mouthwash ↩︎
  6. https://pmc.ncbi.nlm.nih.gov/articles/PMC8751028/ ↩︎
  7. https://www.cuimc.columbia.edu/news/brushing-immediately-after-meals-you-may-want-wait ↩︎
  8. https://aaoinfo.org/blog/should-i-floss-or-brush-first/ ↩︎
  9. https://www.ada.org/resources/ada-library/oral-health-topics/caries-risk-assessment-and-management ↩︎
  10. https://www.webmd.com/oral-health/guide/smoking-oral-health ↩︎

Medical Disclaimer: The information and reference materials contained here are for general informational purposes only and do not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. The use of this information and the information linked is at the reader’s own risk. This is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Readers should not disregard or delay in obtaining medical advice for any medical condition they may have, and readers should seek the assistance of their healthcare professionals for any such conditions.